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Effects of occupational stress management intervention programs: A meta-analysis.

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Effects of Occupational Stress Management Intervention Programs: A Meta-Analysis Katherine M. Richardson and Hannah R. Rothstein Baruch College, City University of New York A meta-analysis was conducted to determine the effectiveness of stress management interventions in occupational settings. Thirty-six experimental studies were included, representing 55 interven- tions. Total sample size was 2,847. Of the participants, 59% were female, mean age was 35.4, and average length of intervention was 7.4 weeks. The overall weighted effect size (Cohen’s d) for all studies was 0.526 (95% confidence interval 0.364, 0.687), a significant medium to large effect. Interventions were coded as cognitive– behavioral, relaxation, organizational, multimodal, or alternative. Analyses based on these subgroups suggested that intervention type played a mod- erating role. Cognitive– behavioral programs consistently produced larger effects than other types of interventions, but if additional treatment components were added the effect was reduced. Within the sample of studies, relaxation interventions were most frequently used, and organiza- tional interventions continued to be scarce. Effects were based mainly on psychological outcome variables, as opposed to physiological or organizational measures. The examination of additional moderators such as treatment length, outcome variable, and occupation did not reveal significant variations in effect size by intervention type. Keywords: stress management, meta-analysis, employee intervention Employee stress has increasingly become a con- cern for many organizations. To paraphrase the “fa- ther of stress,” Hans Selye, stress is an unavoidable consequence of life, and therefore an unavoidable consequence of organizations. Americans are work- ing longer and harder, and job stress continues to increase. The average work year for prime-age work- ing couples in the United States increased by nearly 700 hours in the past two decades (Murphy & Sauter, 2003; U.S. Department of Labor, 1999). From 1997 to 2001, the number of workers calling in sick be- cause of stress tripled. The American Institute of Stress reported that stress is a major factor in up to 80% of all work-related injuries and 40% of work- place turnovers (Atkinson, 2004). This is not solely an American phenomenon. The Confederation of British Industry reported stress as the second highest cause of absenteeism among nonmanual workers in the United Kingdom, and the European Foundation for the Improvement of Living and Working Condi- tions reported that stress affects a third of the Euro- pean working population (Giga, Cooper, & Faragher, 2003). In Australia, most states report an increasing number of annual workers’ compensation claims resulting from workplace stress (Caulfield, Chang, Dollard, & Elshaug, 2004). Organizations provide a major portion of the total stress experienced by a person as a result of the amount of time spent on the job, the demands for performance, and the interaction with others in the workplace (DeFrank & Cooper, 1987). Although it is not possible to eliminate stress en- tirely, people can learn to manage it. Many organi- zations have adopted stress management training pro- grams to try and reduce the stress levels of their workforce. A stress management intervention (SMI) is any activity or program initiated by an organization that focuses on reducing the presence of work-related stressors or on assisting individuals to minimize the negative outcomes of exposure to these stressors (Ivancevich, Matteson, Freedman, & Phillips, 1990). Interest in strategies to reduce stress at work has increased steadily since the 1970s. According to the U.S. Department of Health and Human Services, national surveys conducted in 1985, 1992, and 1999 found the prevalence of stress management and coun- seling programs among private-sector worksites in those years was 27%, 37%, and 48%, respectively (Nigam, Murphy, & Swanson, 2003). The popularity Katherine M. Richardson and Hannah R. Rothstein, De- partment of Management, Zicklin School of Business, Ba- ruch College, City University of New York. Correspondence concerning this article should be addressed to Katherine M. Richardson, Baruch College, City University of New York, One Bernard Baruch Way, New York, NY 10010. E-mail: [email protected] Journal of Occupational Health Psychology 2008, Vol. 13, No. 1, 69 –93 Copyright 2008 by the American Psychological Association 1076-8998/08/$12.00 DOI: 10.1037/1076-8998.13.1.69 69This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. of worksite stress management programs has grown significantly abroad as well as in the United States. Job Stress and Interventions Newman and Beehr (1979, p.1) defined job stress as “a situation wherein job-related factors interact with the worker to change his or her psychological and/or physiological condition such that the person is forced to deviate from normal functioning.” Implicit in this definition is the belief that work-related factors are a cause of stress and that the individual outcomes may be psychological, physiological, or some com- bination of these. A SMI may attempt to change these work-related factors, assist employees in minimizing the negative effects of these stressors, or both. Ivancevich et al. (1990) developed a conceptual framework for the design, implementation, and eval- uation of SMIs. According to the model, interven- tions can target three different points in the stress cycle: (a) the intensity of stressors in the workplace, (b) the employee’s appraisal of stressful situations, or (c) the employee’s ability to cope with the outcomes. The components of actual SMIs vary widely, encom- passing a broad array of treatments that may focus on the individual, the organization, or some combination (DeFrank & Cooper, 1987; Giga, Noblet, Faragher, & Cooper, 2003). Interventions may be classified as primary, sec- ondary, or tertiary. Primary interventions attempt to alter the sources of stress at work (Murphy & Sauter, 2003). Examples of primary prevention programs include redesigning jobs to modify workplace stres- sors (cf. Bond & Bunce, 2000), increasing workers’ decision-making authority (cf. Jackson, 1983), or providing coworker support groups (cf. Carson et al., 1999; Cecil & Forman, 1990; Kolbell, 1995). In contrast, secondary interventions attempt to reduce the severity of stress symptoms before they lead to serious health problems (Murphy & Sauter, 2003). Tertiary interventions—such as employee assistance programs—are designed to treat the employee’s health condition via free and confidential access to qualified mental health professionals (Arthur, 2000). The most common SMIs are secondary prevention programs aimed at the individual and involve instruc- tion in techniques to manage and cope with stress (Giga, Cooper, & Faragher et al., 2003). Examples are cognitive– behavioral skills training, meditation, relaxation, deep breathing, exercise, journaling, time management, and goal setting. Cognitive– behavioral interventions are designed to educate employees about the role of their thoughts and emotions in managing stressful events and to provide them with the skills to modify their thoughts to facilitate adaptive coping (cf. Bond & Bunce, 2000). These interventions are intended to change individuals’ appraisal of stressful situations and their responses to them. For example, employees are taught to become aware of negative thoughts or irra- tional beliefs and to substitute positive or rational ideas (Bellarosa & Chen, 1997). Meditation, relaxation, and deep-breathing inter- ventions are designed to enable employees to reduce adverse reactions to stresses by bringing about a physical and/or mental state that is the physiological opposite of stress (cf. Benson, 1975). Typically, in meditation interventions, the employee is taught to focus on a single object or an idea and to keep all other thoughts from his or her mind, although some programs teach employees to observe everything that goes through their mind without getting involved with or attached to them. Meditation interventions often also include relaxation therapy and deep breath- ing exercises. Relaxation therapy focuses on the con- scious and controlled release of muscle tension. Deep breathing exercises focus on increasing the intake of oxygen and the release of carbon dioxide, although muscle and mental relaxation is often an additional goal of slowing and deepening the breath. Exercise programs generally focus on providing a physical release from the tension that builds up in stressful situations, increasing endorphin production, or both, although some have the goal of focusing the employee’s attention on physical activity (rather than on the stressors) or providing an outlet for anger or hostility (cf. Bruning & Frew, 1987). Journaling interventions require the employee to keep a journal, log, or diary of the stressful events in his or her life (cf. Alford, Malouff, & Osland, 2005). The journal is used as a means of assisting the em- ployee to monitor stress levels, to identify the recur- ring causes of stress, and to note his or her reactions. Journals are also used to formulate action plans for managing stress. Time management and goal-setting interventions are designed to help people manage their time better, both on and off the job. Employees often operate under time pressure and are required to work on multiple tasks simultaneously. Working under such conditions can be particularly stressful. Time man- agement interventions provide skills training in the areas of goal setting, scheduling and prioritizing tasks, self-monitoring, problem solving, delegating, negotiating, and conflict resolution (cf. Bruning & Frew, 1987; N. C. Higgins, 1986). 70 RICHARDSON AND ROTHSTEINThis document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

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